One or Two Internal Thoracic Grafts? Long-term Follow-up of 1043 Off Pump Coronary Bypass Surgeries

Background: The potential survival benefit of a bilateral internal thoracic artery (BITA) grafts over a single ITA (SITA) graft in patients undergoing off pump coronary bypass surgery (OPCAB) is a controversial issue. Our objective was to compare early and long-term outcomes of multi-vessels coronary patients undergoing OPCAB with BITA to those of patients undergoing OPCAB with SITA and other conduits(Saphenous veins or Radial artery)

Methods: Between 1996 and 2008, 1043 consecutive multivessels patients(650 BITA and 428 SITA ) underwent OPCAB surgery at our institute.

Results: Female gender (21.8% vs. 36.2%, p = 0.009), diabetes (35.1% vs. 53.7%, p > 0.001) recent myocardial infarction (26.2% vs. 33.4%, p > 0.001), age 70+ years (42.3% vs. 50%, p = 0.008), peripheral vascular disease (20.7% vs.34.3%, p > 0.001) and chronic renal failure (8.3% vs. 15.9%, p > 0.001) were less frequent in the BITA group vs. the SITA group, respectively. The SITA group’s Logistic Euro-SCORE was significantly higher (16.1 vs. 7.8 BITA group, p = 0.001)

Operative mortality (1.8% BITA vs. 2.8% SITA) and sternal wound infections (2% BITA vs. 2.1% SITA) were similar. The mean follow-up was 12.73 ± 4.95 years. The BITA group’s 10-year survival (Kaplan-Meier) was significantly better (72.2% vs. 54.2% SITA, log-rank test, p > 0.001). Assignment to the BITA group was associated with better propensity-adjusted survival (p = 0.010 vs. SITA, Cox model).

Conclusions: The findings of this large cohort study suggest that early and long-term outcomes for patients undergoing OPCAB surgery are better with BITA grafting.